Home Health Groupings Model Has a 50/50 Chance

By Elizabeth Ecker | October 17, 2017

Long Beach, Calif. — The Home Health Groupings Model, originally proposed by the Centers for Medicare and Medicaid Services (CMS) in July, is looking more likely to become a final rule based on signs from the nation’s capital, the National Association for Home Care and Hospice indicated Monday.

The chances of the groupings model being pulled or delayed by CMS are about 50/50, according to Bill Dombi, president of NAHC.

In recent weeks, industry organizations, stakeholders, providers and members of Congress have pushed back against the proposed rule, which could lead to payment cuts of as much as 15%, based on industry estimates. As of September, the likelihood of HHGM being finalized seemed lower, but the chances have risen, Dombi said during the association’s national conference in Long Beach this week.

CMS will likely post a final decision on the proposal on Nov. 1, following a public comment period on the Federal Register that ended Sept. 25, Dombi said.

“We are concerned about whether this rule will be finalized in the next week or two,” Dombi said during a conference panel discussion Monday. “We think the chances are not even 50/50 that [CMS] will pull the rule. We believe CMS cares but doesn’t have control over this particular aspect [of payment regulations].”

While CMS may be more open to the industry’s response to the proposal, the Office of Management and Budget (OMB) may have a heavy hand in deciding to keep the model, Dombi said.

The rule is being touted as among the most impactful changes to take place in the home health market, and would lead to serious cuts in payments to providers, in part based upon episodes of care being defined as 30-day events rather than 60-day events. According to CMS’ own estimates, the model would cut $950 million from home health in 2019 alone. Stakeholders left more than 1,300 comments on the Federal Register during the public comment period, largely protesting the proposal.

Some in the industry are more confident in the ability of home health care agencies to adapt to the groupings model, as the industry has undergone many substantial changes in recent decades, including a major payment adjustment in 1997. However, home health care providers are also dealing with an onslaught of changes, including the new Conditions of Participation (CoPs), which are slated to go into effect Jan. 13, 2018.

“If this is going to take place in 2019, our industry is going to be in another reinvention of itself,” said Mark Sharp, partner with CPA and advisory firm BKD, LLP. “The providers are going to pivot; it’s what we do.”

But for those that cannot withstand the payment reductions, there could be ethical considerations, Dombi noted. Namely, if providers continue to admit all qualifying patients, regardless of the reduced payments, they may be driven out of business—ultimately not being able to provide care for any patients.

“If you’re out of business, you’re not providing care to anyone,” Dombi said. “Is it better to say ‘yes’ to everyone and go out of business, or say ‘no’ to stay in business? There are ethical dilemmas. It doesn’t make us comfortable to have this conversation.”

Dombi noted that NAHC was “unpleasantly surprised” by the proposal, as it appeared to contrast the rhetoric of the Trump administration and new leaders at CMS and the Department of Health and Human Services (HHS). The new administration has frequently stated it aims to reduce regulations.

NAHC is prepared to act if the rule does move forward, in the form of a lawsuit that would challenge the rule in hopes to alter it or stifle it before it would take effect January 1, 2019.

“We’re not finished on this issue,” Dombi said. “If this comes out, we have a window of opportunity until 2019. We have considered filing a lawsuit. It’s a tough case. We are prepared to take this fight as far as it has to go.”

Curious about all things, when not writing about senior housing topics, Liz is an avid explorer of food. She loves trying new recipes, new restaurants and new ice cream flavors. (Current favorite: Goat cheese with red cherries.)